National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Tob Control. 2019 Nov;28(6):669-675. doi: 10.1136/tobaccocontrol-2018-054583. Epub 2018 Oct 15.
Understanding disparities in the burden of cancer attributable to smoking is crucial to inform and improve tobacco control measures. In this report, we estimate the population attributable fraction (PAF) of cancers deaths attributable to smoking at the national and provincial levels in China.
Using cancer mortality data from 978 counties, smoking data from a nationwide survey and relative risks from a prospective study of 0.5 million adults in China, we calculated the absolute (non-standardised) and standardised numbers and proportions of cancer deaths among adults 30 years and older attributable to active and second-hand smoking in 2014 across all 31 provinces in Mainland China.
The estimated number of cancer deaths attributable to smoking in China in 2014 was 342 854 among men and 40 313 among women, of which second-hand smoking accounted for 1.8% and 50.0%, respectively. Among men, the absolute PAF in China was 23.8%, ranging from 14.6% in Xinjiang to 26.8% in Tianjin; the overall standardised PAF was 22.2%, ranging from 15.7% in Xinjiang to 26.0% in Guizhou. Among women, the overall absolute and standardised PAFs were 4.8% and 4.0%, ranging from 1.8% and 1.6% in Jiangxi to 14.9% and 9.6% in Heilongjiang, respectively. Overall, provinces with the highest standardised PAFs among men were located in Southwest China and among women in the Northeast.
Comprehensive smoke-free policies in China should expand to all provinces, notably those with a higher burden of cancer attributable to smoking, instead of being mostly limited to Beijing and some other metropolitan areas.
了解吸烟导致的癌症负担差异对于制定和完善烟草控制措施至关重要。本报告旨在估计中国国家和省级层面因吸烟导致的癌症死亡的人群归因分数（PAF）。
我们使用了来自全国调查的吸烟数据和来自中国 500 万成年人的前瞻性研究的相对风险数据，对全国 978 个县的癌症死亡率数据进行了分析，计算了 2014 年中国所有 31 个省份 30 岁及以上成年人中因主动吸烟和二手烟导致的癌症死亡的绝对（非标准化）数量和比例。
2014 年中国因吸烟导致的癌症死亡人数为男性 342854 例，女性 40313 例，其中二手烟分别占 1.8%和 50.0%。男性中，中国的绝对 PAF 为 23.8%，范围从新疆的 14.6%到天津的 26.8%；整体标准化 PAF 为 22.2%，范围从新疆的 15.7%到贵州的 26.0%。女性中，整体绝对和标准化 PAF 分别为 4.8%和 4.0%，范围从江西的 1.8%和 1.6%到黑龙江的 14.9%和 9.6%。总体而言，男性 PAF 标准化值最高的省份位于中国西南部，女性 PAF 标准化值最高的省份位于中国东北部。
中国的全面无烟政策应扩大到所有省份，特别是那些癌症负担与吸烟相关较高的省份，而不仅仅局限于北京和其他一些大都市地区。
